AB0245 PULMONARY INVOLVEMENT IN RHEUMATOID ARTHRITIS AND SECONDARY SJÖGREN SYNDROME
Authors: A. R. Halidou, K. Nassar, S. Janani
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is a severe inflammatory disease that affects the joints and other organs such as the lung. Gougerot-Sjögren’s syndrome (GSS) is an autoimmune disease. Secondary GSS can be primary or secondary and is defined by (1) the presence of another connective tissue disease, (2) the existence of dry eyes or dry mouth, and (3) objective evidence of ocular or salivary involvement. The presence of anti-SSA or anti-SSB antibodies is not necessary for the diagnosis of secondary SMS (4). The association of the two pathologies (RA-SGS) is frequent, and apart from osteoarticular involvement, various organs can be affected, in this case the lungs, by one or the other pathology with similar pulmonary lesions. Objectives To determine the incidence of pulmonary involvement in a population of RA-SGS patients. Methods Retrospective study, conducted from January 2019 to October 2021, at the rheumatology department of the CHU Ibn Rochd of Casablanca. Inclusion criteria: patients followed for RA according to the diagnostic criteria (EULAR/ACR 2010) associated or not with secondary GSS. Exclusion criteria: patients followed for primary GSS alone or other inflammatory rheumatic diseases with pneumopathy. Results 139 patients were included in our study, with a female predominance of 96.40%. The mean age was 56.31 years, the mean duration of RA was 9.89 years (4 months - 34 years). GSS was associated in about 1/3 of the patients, 33.81%. In the study population 24.46% of patients had pulmonary involvement which was present in the majority of RA-SGS patients (63.83%). Clinically, exertional dyspnea was found in all these patients and chronic dry cough in 66.67%. On standard radiography, an interstitial syndrome was found in all of these patients and on the pulmonary CT scan, 2 patients were at the stage of pulmonary fibrosis, i.e. 6.67% (PR-SGS). Discussion Secondary GSS is found in 30% of patients with rheumatoid arthritis (3). Pulmonary infiltrative disease is similar in both conditions. In RA these diseases are in the foreground after pleural involvement. They have the same clinical, radiological and functional characteristics, associated to varying degrees with exertional dyspnea, dry cough, crepitus rales, and digital hippocrasis (5,6). Pulmonary involvement is frequent in SSc, mainly represented by diffuse interstitial lung disease and bronchial and bronchiolar involvement (7). In SSc, the prognosis is rarely life threatening (8). In RA, the overall prognosis of rheumatoid lung disease remains poor with significant morbidity and mortality. A particular evolutionary mode characterized by acute exacerbation of interstitial lung disease associated with connective tissue diseases has been reported, particularly in RA (9,10). Conclusion In our series, the frequency of association of secondary SSG with RA is similar to the data in the literature and lung involvement is particularly frequent in these patients. No study in the literature has looked specifically at the clinical and prognostic features of lung involvement in RA-SGS patients. References [1]Crestani B and al. Respiratory manifestations in Gougerot-Sjögren’s syndrome. Rev Mal Respir 2007. [2]Sauvezie B and al. Syndrome de Gougerot-Sjögren. Encycl Méd Chir Appareil locomoteur. Elsevier SAS, Paris, 2000. [3]Picone O and al. Gougerot-Sjögren syndrome in obstetric gynecology. J Gynecol Obstet Biol Reprod 2006. [4]Vitali C and al. Classification criteria for Sjogren’s syndrome. Ann Rheum Dis 2002. [5]Despaux J and al. Incidence and etiopathogenic aspects. Rev Med Interne 1997. [6]Remy-Jardin M and al. Lung changes in rheumatoid arthritis: CT findings. Radiology 1994. [7]Y. Uzunhan et al. Pulmonary and bronchial manifestations of Gougerot-Sjögren syndrome. 28.02.2021. [8]Z. Teyeb et al. Pulmonary involvement in Sjögren’s syndrome. [9]Tsuchiya Y et al. Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome. Eur Respir J 2011. [10]Suda T et al. Acute exacerbation of interstitial pneumonia associated with collagen vascular disease. Respir Med 2009. Disclosure of Interests None declared